Clinical Rheumatology

, Volume 14, Issue 3, pp 308–314 | Cite as

Isometric and isokinetic quadriceps strength in gonarthrosis; Inter-relations between quadriceps strength, walking ability, radiology, subchondral bone density and pain

  • O. R. Madsen
  • H. Bliddal
  • C. Egsmose
  • J. Sylvest


Patients with osteoarthrosis suffer from disability and pain. We measured isokinetic and isometric peak torque in 20 women with gonarthrosis (GA) and in 26 healthy controls. Relationships between muscle strength, walking and stair climbing time, pain level and pain disability scores as assessed by the patients using an extensive questionnaire, radiological changes and subchondral sclerosis expressed as bone mineral density (BMD, g/cm2) of the proximal tibia were studied.

Precision errors of the torque measurements in both GA patients and controls were approximately 6%. In the GA patients, isokinetic and isometric quadriceps strength was reduced by 40 and 15% (p<0.01) respectively, and walking and stair climbing time was increased by 30% (p<0.005). Isokinetic strength was a better predictor of pain level and pain disability scores than isometric strength and radiological stage. Walking time and stair climbing time were not associated with quadriceps strength, pain level, pain disability scores or radiological changes. Subchondral BMD was not predictive of pain.

The study suggests that quadriceps strength assessed by isokinetic dynamometry in GA is a reliable measurement. Isokinetic strength was pronouncedly reduced compared to isometric strength and was a more important predictor of pain and pain disability than isometric strength. These findings should be taken into consideration when planning exercise studies and programmes in GA.

Key words

Osteoarthrosis Muscle Strength Disability Radiology Bone BMD Pain 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ekdahl, C., Andersson, S.I., Svensson, B. Muscle function of the lower extremities in rheumatoid arthritis and osteoarthrosis. J Clin Epidemiol 1989, 42, 947–954.Google Scholar
  2. 2.
    Fisher, N.M., Pendergast, D.R., Gresham, G., Calkins, E. Muscle rehabilitation: Its effect on muscular and functional performance of patients with knee osteoarthritis. Arch Phys Med Rehabil 1991, 72, 367–374.Google Scholar
  3. 3.
    Chamberlain, M.A., Care, G., Harfield, B. Physiotherapy in osteoarthrosis of the knees. A controlled trial of hospital versus home exercises. Int Rehab Med 1982, 4, 101–106.Google Scholar
  4. 4.
    Nordesjö, L., Nordgren, B., Wigren, A., Kolstad, K. Isometric strength and endurance in patients with severe rheumatoid arthritis or osteoarthrosis in the knee joints. Scan J Rheumatol 1983, 12, 152–156.Google Scholar
  5. 5.
    Kellgren, J.H. Pain in osteoarthritis. J Rheumatol 1983, 10, 108–109.Google Scholar
  6. 6.
    Kellgren, J.H., Lawrence, J.S. Radiologic assessment of osteoarthritis. Ann Rheum Dis 1957, 16, 494–501.Google Scholar
  7. 7.
    Danneskiold-Samsoe, B., Kofod, V., Munter, J., Grimby, J. Muscle strength and functional capacity in 78–81-year-old men and women. Eur J Appl Physiol 1984, 52, 310–314.Google Scholar
  8. 8.
    Mawdsley, R.H., Knapik, J.J. Comparison of isokinetic measurements with test repetitions. Phys Ther 1982, 62, 169–172.Google Scholar
  9. 9.
    Madsen, O.R., Schaadt, O., Bliddal, H., Egsmose, C., Sylvest, J. Relationship between quadriceps strength and bone mineral density of the proximal tibia and distal forearm in women. J Bone Miner Res 1993, 8, 1439–1444.Google Scholar
  10. 10.
    Gransberg, L., Knutsson, E. Determination of dynamic muscle strength in man with acceleration controlled isokinetic movements. Acta Physiol Scand 1983, 119, 317–320.Google Scholar
  11. 11.
    Madsen, O.R., Schaadt O., Bliddal, H., Egsmose, C., Sylvest, J. Bone mineral distribution of the proximal tibia in gonarthrosis assessed in vivo by photon absorption. Osteoarthritis and Cartilage 1994, 2, 141–147.Google Scholar
  12. 12.
    Fairbank, J.C.T., Couper, J., Davies, J.B., O'Brian, J.P. The Oswestry Low Back Pain Disability Questionnaire. Physiotherapy 1980, 66, 271–273.Google Scholar
  13. 13.
    Kirkwood, B.R. Essentials in Medical Statistics. Blackwell Scientific Publications, 1988. London, UK.Google Scholar
  14. 14.
    SPSS/PC+StatisticsTM 4.0 [manual]. SPSS Inc, 1990. Chicago, IL 60611, USA.Google Scholar
  15. 15.
    Giles, B., Henke, P., Edmunds, J., McNeil, D. Reproducibility of isokinetic muscle strength measurements in normal and in arthritic individuals. Scand J Rehab Med 1990, 22, 93–99.Google Scholar
  16. 16.
    Danneskiold-Samsoe, B., Grimby, G. Isokinetic and isometric muscle strength in patients with rheumatoid arthritis. The relationship to clinical parameters and the influence of corticosteroids. Clin Rheumatol 1986, 5, 459–468.Google Scholar
  17. 17.
    Lankhorst, G.J., Van de Stadt, R.J., Van der Korst, J.K. The relationships of functional capacity, pain, and isometric and isokinetic torque in osteoarthrosis of the knee. Scan J Rehab Med 1985, 17, 167–172.Google Scholar
  18. 18.
    Johnson, T. Age-related differences in isometric and dynamic strength and endurance. Phys Ther 1982, 62, 985–989.Google Scholar
  19. 19.
    Felson, D.T., Anderson, J.J., Naimark, A., Walker, A.M., Meenan, R.P. Obesity and knee osteoarthritis. The Framingham study. Ann Intern Med 1988, 109, 18–24.Google Scholar
  20. 20.
    Dastur, D.K., Gagrat, B.M., Marghane, D.K. Human muscle in disuse atrophy. Neuropathol Appl Neurobiol 1979, 5, 85–91.Google Scholar
  21. 21.
    Glasberg, M.R., Glasberg, J.R., Jones, R.E. Muscle pathology in total knee replacement for severe osteoarthritis: A histochemical and morphometric study. Henry Ford Hosp Med J 1986, 34, 37–40.Google Scholar
  22. 22.
    Harries, U.J., Bassey, E.J. Torque-velocity relationships for the knee extensors in women in their 3rd and 7th decades. Eur J Appl Physiol 1990, 60, 187–190.Google Scholar
  23. 23.
    Grimby, G., Aniansson, A., Zetterberg, C., Saltin, B. Is there a change in relative fibre composition with age? Clin Physiol 1984, 4, 189–194.Google Scholar
  24. 24.
    Stokes, M., Young, A. The contribution of reflex inhibition to arthrogenous muscle weakness. Clin Science 1984, 67, 7–14.Google Scholar
  25. 25.
    Hurley, M.V., Newham, D.J. The influence of arthrogenous muscle inhibition on quadriceps rehabilitation of patients with early, unilateral osteoarthritic knees. Br J Rheum 1993, 32, 127–131.Google Scholar
  26. 26.
    Shakespeare, D.T., Stokes, M., Sherman, K.P. Reflex inhibition in the quadriceps after menisctomi: Lack of association with pain. Clin Physiol 1985, 5 137–144.Google Scholar
  27. 27.
    Dekker, J., Boot, B., Van der Woude, L.H.V., Bijlsma, J.W.J. Pain and disability in osteoarthritis: A review of biobehavioral mechanisms. J Behav Med 1992, 15, 189–214.Google Scholar
  28. 28.
    Davis, M.A. Sex differences in reporting osteoarthrotic symptoms: A sociomedical approach. J Health Soc Behav 1981, 22, 298–310.Google Scholar
  29. 29.
    Massadaro, L., Watt, I., Cushnaghan, J., Dieppe, P. Osteoarthrosis of the knee joint: An eight year prospective study. Ann Rheum Dis 1989, 48, 893–897.Google Scholar

Copyright information

© Acta Medica Belgica 1995

Authors and Affiliations

  • O. R. Madsen
    • 1
  • H. Bliddal
    • 1
  • C. Egsmose
    • 1
  • J. Sylvest
    • 1
  1. 1.Department of RheumatologyCopenhagen Municipal HospitalKøbenhavn KDenmark

Personalised recommendations